Healthcare Provider Details

I. General information

NPI: 1154712156
Provider Name (Legal Business Name): IMPACT MEDICAL STAFFING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 HARP DR
RIPON CA
95366-9334
US

IV. Provider business mailing address

193 HARP DR
RIPON CA
95366-9334
US

V. Phone/Fax

Practice location:
  • Phone: 209-603-0716
  • Fax: 209-599-7478
Mailing address:
  • Phone: 209-603-0716
  • Fax: 209-599-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number9409
License Number StateCA

VIII. Authorized Official

Name: MELANIE AQUINO DUNNIWAY
Title or Position: PRESIDENT
Credential: OT
Phone: 209-603-0716